MEDICARE: MRS. CAROL ANN GORDON DELOOPER APN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024175773	VA

General Provider Information

NPI Number	:	1295071421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL ANN GORDON DELOOPER APN, FNP-BC

Provider Business Mailing Address
First Line	:	43934 ROCHELLE CT
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20147-3816
Country	:	US
Telephone Number	:	609-273-0981
Fax Number	:

Provider Business Practice Location Address
First Line	:	21001 SYCOLIN RD STE 180
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20147-4074
Country	:	US
Telephone Number	:	609-687-4363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2012
Last Update Date	:	02/20/2026

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